Doctor Answers 8

You are correct in your description of cohesive gel implants, but the cohesive gel effect is seen only with implant rupture.

That is very different from what is called "leakage". Leakage of silicone gel implants commonly refers to the diffusion of very minute tiny amounts of silicone fluid that can very slowly migrate through the implant shell. This is often referred to as "sweating" of the silicone through the implant shell.

Newer implants have a much improved implant shell which keeps this type of leakage to a minimum. The newer implants are safe, approved by the FDA, and silicone leakage is minimal. Long term studies have shown that bthere are no proven systemic effects of this silicone.

With the new implants you are safe from leakage as best we know.

April 17th, 2009

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Silicone breast implants have had a bad rap for many years for good reasons, The gel implants of the 60s and 70s and even the 80s had a lot of problems. They were made of thin shells and liquid silicone and over time most have broken or leaked with troubling results such as hardness, capsular contracture or pain. While nothing is for sure, the new implants have stronger capsules and a coherent gel. I have used them very successfully for years. It is with out question that our best laid plans are often wrong, it seem that the problem with leakage and breakage have been, as best we can hope, resolved.

Silicone gel implants can leak, and all will do so over time

April 17th, 2009

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To avoid confusion I think we should define what a leak is concerning breast implants. Breast implants are made of two components, an outer silicone shell and a fill material of silicone gel. The shell or container of the implant material is a silicone rubber elastomer, and has a chemical coating to reduce the bleed or leak of the silicone material within. Chemically this is a very different creature, a rubber like substance, and not similar at all to silicone gel. An implant may contain saline, or silicone gel of various consistencies or "cohesiveness", the tendency of the material to stick to itself. The silicone gel can get through the covering by bleed, yes the gel can work its way through an intact covering, or through a tear in the covering. Over time all implants wear and the cover will tear and result in a leak. The leak means that the material on the inside will reach the outside of the silicone rubber cover and touch the tissues of the body directly.

So simply stated, a leak is when the shell tears and the inside material gets on the outside. What does this do? The gel material causes irritation in the adjacent tissue with tenderness, drawing, capsule contracture, and calcium deposits in the scar around the implant.

All breast implants require care and eventual replacement, so choose a surgeon who will be there for you.

Breast Implants Pictures

YES THEYT CAN

April 17th, 2009

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I beg to differ from the other surgeon. Although the implant gel is more cohesive than they used to be, the shell of the implant can wear a hole in it and you have what is called a "silent rupture". It is called this because they are very difficult to impossible to detect without a MRI and most patients have no symptoms of the leak. Even the FDA recommends serial MRI's after silicone gel breast augmention.

They may rupture, but they are less likely to migrate

April 20th, 2009

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The new cohesive gel implants are made of an outer shell and an inner cohesive gel of silicone (a "jello"-like substance). Over time, the shell can weaken and open (rupture) but given the consistency of the silicone gel, it is unlikely to migrate or "leak" far into the surrounding tissues-- this is different that the older gel implants that we no longer use. Now, it can still be in contact with surrounding tissues and cause capsular contracture or cosmetic changes, and it would need to be replaced if a rupture was detected (usually by MRI in most cases), but some of the bad complications from the old silicone implants are very unlikely to occur.

Silicone breast implant leaks

The term "leak" refers to a rupture in the implant shell. Even though the silicone gel may not travel far from the implant if the shell has ruptured we still consider that a leak.

The very point you raise is part of the reason that implant manufacturers and the FDA are suggesting that patients get MRI's for follow-up every 2-3 years. It can be very difficult to diagnose implant leaks or ruptures in silicone implants with just physical exam.

All implants wear out eventually. Gel: MRI tests

April 19th, 2009

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Ms. Jackson:

Having a silicone gel implant should work for you for many years, but all implants should eventually be expected to wear out. The silicone polymer shell around the filler can weaken with years of use. It may not cover or contain the silicone gel, whether it is less or more cohesive, forever. This is similar to saline implant deflation. Even though cohesive gel won't ooze out of a cut implant, that does not mean you should ignore an old gel implant.

In our practice we tell all patients that breast implants may not be one-time, permanent devices. Patients should expect to have them changed years in the future.

If you had recent silicone implants placed, your surgeon probably told you of the Food and Drug Administration's (FDA) recommendation that patients with silicone gel implants undergo regular magnetic resonance imaging (MRI) tests to evaluate the implant for leakage. This allows your surgeon to discuss with you the decision about timing of removal and replacement. This is not necessary with saline filled implants.

Silcone implants don't leak

April 17th, 2009

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You are correct in that the silicone used in implants now is cohesive, meaning that it is a semi-solid. You can cut them in half and the gel doesn't go anywhere. Some people are confused because the "gummy bear" implants were originally called cohesive implants, for the same reason. This created the impression that they have a cohesive gel while other implants don't; this is not correct, the gel is just firmer.

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